BACKGROUND: Nigeria adopted the use of dolutegravir (DTG)-based regimen as the preferred first line ART regimen for children living with HIV (CLHIV) in July 2021 and immediately commenced transitioning those on protease inhibitor (PI)-based regimen to DTG. This paper aims to assess virological dynamic upon transitioning from PI- to DTG-based regimen amongst CLHIV in Nigeria.
METHODS: We conducted an institutional-based retrospective cohort study using data from the electronic medical records from 155 health facilities in Akwa Ibom and Cross River States support by PEPFAR through United State Agency for International Development (USAID). The cohort included CLHIV (<=9years) who were transitioned from PI-based to DTG-based regimen between July 2021 and December 2021. The baseline viral load at transitioning and 12months after transition was abstracted, and categorized as undetectable viral load (<=40copies/ml), low-level viremia (41-999copies/ml), or unsuppressed) viral load (>=1000copies/ml. Chi-square statistics was used to compare proportional difference in viral load change using STATA version 14 with statistical significance set at p<0.05.
RESULTS: A total of 2,358 CLHIV were transitioned to DTG-based regimen as of December 2021. Median age was 6years [IQR: 4–7years], and 51.0% (n=1,203) were females. At baseline 81.6% (n=1,924) were undetectable, 14.6% (n=345) had low-level viremia while 3.8% (n=89) were unsuppressed (>=1000copies/ml). Of the 2,148 (91.1%) CLHIV who remained on ART 12months after transitioning, 90.6% (n=1,947) were undetectable, 7.0% (n=150) had low-level viremia while 2.4% (n=51) were unsuppressed (>=1000copies/ml). There was no sex difference in virological dynamics [Male=91.7% versus Female = 92.5%; p = 0.374].
CONCLUSIONS: Children living with HIV achieved favourable virological changes when transitioned to DTG-based regimen. Programs should prioritize DTG-based regimen in children in order to improve their treatment outcomes.